Med-Surg Intro Respiratory System PDF

Introduction to the Respiratory System By: Michelle M. Melton BSN, RN Chapter Objectives  Describe the normal structures and functions of the respiratory system  Identify how aging affects the respiratory system  List the data to collect when caring for a patient with a respiratory disorder...

Introduction to the Respiratory System By: Michelle M. Melton BSN, RN Chapter Objectives  Describe the normal structures and functions of the respiratory system  Identify how aging affects the respiratory system  List the data to collect when caring for a patient with a respiratory disorder  Recognize expected findings when inspecting, palpating, percussing, and auscultating the chest  Identify common diagnostic tests performed to diagnose disorders of the respiratory system  Plan nursing care for patients undergoing each of the diagnostic tests  Discuss therapeutic measures used to help patients with respiratory disorders Normal Respiratory Anatomy The respiratory system is divided into the upper airway and lower airway. Upper Airway Lower Airway  Nose  Trachea  Sinuses  Bronchi  Turbinates  Bronchioles  Pharynx  Lungs  Larynx  Alveoli Upper and Lower Respiratory Tract Nose and Nasal Cavities Nose  Nares are external openings of the nose.  Internal nose is divided into two cavities separated by nasal septum.  Vascular and ciliated mucous lining of the nasal cavities warms and humidifies inspired air.  Nasal mucosa contains olfactory sensory cells that are responsible for the sense of smell.  As well, if our oral cavity is filled with food during chewing, we can still breathe through our nose.  When our nasal passages are blocked, the only way we can breathe is through our mouths. Nose and Nasal Cavities Turbinate Bones (Conchae)  Change the flow of inspired air to moisturize and warm it better.  Large, moist, and warm mucous membrane surface that can trap almost all dust and microorganisms.  Contain sensitive nerves that detect odors or induce sneezing to remove irritating particles. Nose and Nasal Cavities Paranasal Sinuses  Frontal Sinuses- Lie in the frontal bone that extends above the orbital cavities.  Ethmoid Sinuses- these sinuses are small spaces shaped like a honeycomb. Located along the ethmoid bone which is between the eyes.  Sphenoidal Sinuses- Lie behind the nasal cavity.  Maxillary Sinuses- Found on either side of the nose in the maxillary bones. They are the largest sinuses and the most accessible to treatment. Upper Airway Pharynx (throat)  Carries air from the nose to the larynx and food from the mouth to the esophagus.  Divided into three continuous areas:  Nasopharynx- Near nose an above the soft palate. The nasopharynx contains the adenoids or pharyngeal tonsils and openings of the eustachian tubes. The eustachian tubes connect the pharynx to the middle ear. Tonsils and adenoids do not contribute to respiration but protect against infection.  Oropharynx- Near the mouth. The oropharynx contains the tongue and the Palatine tonsils.  Laryngeal Pharynx- Near the larynx. Upper Airway Larynx (voice box)  Cartilaginous framework between the pharynx and trachea.  Primary function is to produce sound.  Protects the lower airway from foreign objects because it facilitates coughing.  The pharynx, palate, tongue, teeth, and lips mold the sounds made by the vocal cords into speech. Upper Airway Larynx (voice box)  Important structures in the larynx include:  Epiglottis- a cartilaginous valve flap that covers the opening to the larynx during swallowing.  Glottis- An opening between the vocal cords  Vocal Cords- Folds of tissue in the larynx that vibrate and produce sound as air passes through.  Cricoid Cartilage- Only complete cartilaginous ring in the larynx.  Thyroid Cartilage- Largest cartilage in the trachea, part of it forms the Adam’s apple. Upper Airway  Lower Airway Trachea (windpipe)  Hollow tube composed of smooth muscle and supported by c- shaped cartilage.  The cartilaginous rings are incomplete on the posterior surface.  Transports air from the laryngeal pharynx to the bronchi and lungs.  Bifurcates (divides) at the carina (lower end of the trachea) to form the right and left bronchi.  Stimulating the carina causes coughing and bronchospasm as a protective measure. This prevents aspiration of foreign objects into the lower airway. Did You Know It is important for you to keep your airways constantly open, even when you are asleep, however, it is not necessary to keep your esophagus open unless there is food being ingested. The esophagus is collapsed unless there is food in it. Lower Airway Bronchi and Bronchioles  The right mainstem bronchus is shorter, more vertical and larger than the left mainstem bronchus.  Aspiration of foreign objects is more likely to occur in the right mainstem bronchus and right upper lung.  The bronchi branch enter each lobe and continue to branch to form smaller bronchi and, finally, terminal bronchioles (smaller subdivisions of bronchi) Lower Airway Lungs and Alveoli  The lungs are paired elastic structures enclosed by the thoracic cage.  They contain alveoli, small, clustered sacs that begin where the bronchioles end. There are three types of alveolar cells: Type I Cells = 95% of the alveolar surface area; serve as a barrier between the air and the alveolar surface Type II Cells = 5% of area but are responsible for producing type I cells and surfactant; Surfactant reduces surface tension, thereby improving overall lung function Type III Cells = Alveolar macrophages which are phagocytic cells that ingest foreign matter and, as a result, provide an important defense mechanism Type I & Type II cells make up the alveolar epithelium  Adult lungs contain approximately 300 million alveoli.  Capillaries surround these thin-walled alveoli and are the site of exchange of oxygen and CO2. DETAILS OF THE LOWER RESPIRATORY SYSTEM Alveoli Each alveolus _______ (singular) is made of a thin membrane (1 air cell thick) filled with Gas exchange __. happens across the alveolar membrane capillary wall ________________ and ___________. alveolar O2 0.1 wide – 0.2 mm membrane alveolus CO2 capillary wall alveolar sac CO2 or CO2 air sac CO2 alveoli DETAILS OF THE LOWER RESPIRATORY SYSTEM alveoli Each alveolus _______ (singular) is made of a thin membrane (1 air cell thick) filled with Gas exchange __. happens across the alveolar membrane capillary wall ________________ and ___________. two alveoli CO2 alveolar sac or CO2 air sac CO2 alveoli DETAILS OF THE LOWER RESPIRATORY SYSTEM alveoli There 150 are million _________ each alveoli in ____ lung creating a respiratory surface the same size tennis as thecourt surface of a __________. CO2 alveolar sac or CO2 air sac CO2 alveoli DETAILS OF THE LOWER RESPIRATORY SYSTEM alveoli The __________________ pulmonary capillaries supply the alveoli with ____________ blood and deoxygenated oxygenated carry away __________ blood. pulmonary capillaries Accessory Structures Diaphragm-Separates the abdominal and thoracic cavities.  On inspiration, the respiratory muscles contract. The diaphragm also contracts and moves downward (flattens), enlarging (elongating) the thoracic space/chest cavity and creating a partial vacuum.  On expiration, the respiratory muscles relax, and the diaphragm returns to its original position. THE MECHANISM OF VENTILATION QUICK Lay one hand flat above your bellybutton TASK 1 and one below your collar bone. Take five slow breaths. 1) When you inhale and exhale, what do you notice about the volume When of your chest you INHALE, cavity? your chest volume should INCREASE. When you EXHALE, your chest volume should DECREASE. 2) Which requires more effort, inhaling or INHALING requires more effort than exhaling? exhaling because respiratory muscles CONTRACT during inhalation, but they RELAX during exhalation. Let’s see exactly how this THE MECHANISM OF VENTILATION QUICK What differences do you notice about the TASK ribcage and the diaphragm during exhalation and EXHALATI INHALATI inhalation? ON ON diaphrag m THE MECHANISM OF VENTILATION FUN What differences do you notice about the FACTS ribcage and the diaphragm during exhalation and EXHALATI INHALATI inhalation? ON Ribcage is ON Ribcage is lifted lower (intercostals (intercostals contract to lift relax and the Diaphragm is ribcage) ribs fall) dome-shaped Diaphragm is (when relaxed flattened (it it forms a contracts to dome) flatten) no effort needed requires effort chest & lung chest & lung volume decreases volume Accessory Structures Mediastinum- A wall that divides the thoracic cavity into two halves. This wall has two layers of pleura, a saclike serous membrane.  Visceral Pleura- covers the lung surface.  Parietal Pleura- covers the chest wall. Serous fluid within the pleural space separates and lubricates the visceral and parietal pleurae. THE BRONCHIAL TREE (13 min) by Khan Academy MEET THE LUNGS (9.5 min) by Khan Academy Transport of Gases in the Blood Respiratory Physiology  Main function is to exchange oxygen and CO2 (ventilation and gas exchange) between the atmospheric air and the blood and between the blood and the cells. This process is called Respiration. THE NEED FOR A RESPIRATORY SYSTEM FUN Why is gas exchange necessary? FACTS Cellular Respiration C6H12O6 + O2 H2O + CO2 +ATP (energy) Oxygen is a Carbon reactant vital _______ in toxic by-product dioxide is a cellular ______________ respiration of cellular and respiration obtained so it must be removed and so it must inhalation continuously exhalation be ________ continuously THE NEED FOR A RESPIRATORY SYSTEM FUN Why is gas exchange necessary? FACTS Cellular Respiration C6H12O6 + O2 H2O + CO2 +ATP (energy) Recall: GAS EXCHANGE is the opposing transport of oxygen (into) and carbon dioxide (out of) the body. THE NEED FOR A RESPIRATORY SYSTEM QUICK If you hold your breath, eventually the TASK urge to breathe again will become unbearable and you will have to stop holding your breath. Why do you think this is the case? Most of you will probably say it is the need to take in oxygen, but your need to get rid of carbon dioxide is even greater. The buildup of this toxic product in your blood becomes more dangerous more Howquickly than the lack of long can YOU holdoxygen. your breath before you have to THE NEED FOR A RESPIRATORY SYSTEM Cool How long is it possible to hold one’s Facts! breath? Stig Severinsen held his breath for 22min 00sec at the London School of Diving, United Kingdom, on the 3rd of May 2012. He did this by using advanced breathing techniques prior to his attempt. Since then, others have posted longer times and have broken through the 23 minute barrier. Mechanism of Breathing  Ventilation- Movement of air in and out of the respiratory tract. This process requires a patent airway and intact and functioning respiratory muscles. The respiratory centers in the medulla oblongata and pons control rate and depth.  Inspiration- Movement of O2 into the lungs.  Expiration- Removal of CO2 from the lungs. THE MECHANISM OF VENTILATION QUICK Do a normal exhale and then CONTINUE to TASK exhale until you’ve removed as much air from your lungs as you can. What do you notice about the effort needed to do the forced exhalation compared to normal exhalation? LUNG VOLUMES Not counting the residual volume, the maximum amount of air you can move into or out of your vital capacity lungs during forceful breathing is called your ___________ (VC). 4400 – 4800 Typically, VC is between mL _____________ in males 3400 and–_____________ 3800 mL in females. 6000 mL 5000 mL Vital 4000 mLTotal Lung Capacity Capacity (VC) (TLC) 3000 mL 2000 mL Residual 1000 mL Volume (RV) 0 mL LUNG VOLUMES However, no one uses their entire vital capacity during normalInstead, normal breathing usually breathing. 500 mLaround ______ of air at the mid- only moves tidal range of the vital volume capacity. This volume is called ___________ (TV) which takes into account the normal respiratory 6000 mL cycle of inhalation and exhalation. 5000 mL Vital 4000 mLTotal Lung Capacity Capacity (VC) (TLC) 3000 mL Tidal Volume (TV) 2000 mL Residual 1000 mL Volume (RV) 0 mL LUNG VOLUMES After a normal exhalation, the maximum volume of air you can further expelexpiratory from yourreserve lungsvolume is called the ______________________ (ERV). After a normal inhalation, the maximum volume of air you can addinspiratory reserve to your lungs volume is called the _______________________ (IRV). 6000 mL Inspiratory 5000 mL Reserve Volume (IRV) Vital 4000 mLTotal Lung Capacity Capacity (VC) (TLC) 3000 mL Tidal Volume (TV) Expiratory Reserve 2000 mL Volume (ERV) Residual 1000 mL Volume (RV) 0 mL Gas Exchange  Diffusion- Transfer of a substance from an area of higher concentration or pressure to an area of lower concentration or pressure, exchange of O2 and CO2 across the alveolar capillary membrane and at the cellular level.  As cellular CO2 gradients increase, CO2 diffuses from the cells into the capillaries and then into the venous circulatory system.  As CO2 travels to the pulmonary circulation, its concentration is higher there than in the alveoli. Therefore, CO2 diffuses into the alveoli. Gas Exchange REQUIREMENTS FOR GAS EXCHANGE 5)circulatory systemis required to quickly and A ________________ deliver gases___________ to and from the effectively respiratory surface. pulmonary In the lungs, capillaries tiny __________________ wrap around all the alveoli and supply them with blood. Capillary walls are one cell_______ thick which only makes them gas veryexchange efficient for rapid ___________. The BLUE vessels carry carbon dioxide filled alveolu blood (deoxygenated s CO2 O2 blood) to the alveoli. The RED vessels carry oxygen filled blood pulmona (oxygenated ry blood) away from capillary REQUIREMENTS FOR GAS EXCHANGE 5)circulatory systemis required to quickly and A ________________ deliver gases___________ to and from the effectively respiratory surface. pulmonary In the lungs, capillaries tiny __________________ wrap around all the alveoli and supply them with blood. The BLUE vessels carry carbon dioxide filled blood (deoxygenated blood) to the alveoli. The RED vessels carry oxygen filled blood (oxygenated blood) away from REQUIREMENTS FOR GAS EXCHANGE 5)circulatory systemis required to quickly and A ________________ deliver gases___________ to and from the effectively respiratory surface. QUICK How is the circulatory system aiding in TASK creating the partial pressure gradients needed to move bloodOin 2 & CO2? = CO2 pulmonary moist capillary alveolar alveolar airmembrane The capillaries keep on bringing CO2 rich blood TOWARD the alveoli. This creates a higher pP of CO2 in the blood than in the air. REQUIREMENTS FOR GAS EXCHANGE 5)circulatory systemis required to quickly and A ________________ deliver gases___________ to and from the effectively respiratory surface. QUICK How is the circulatory system aiding in TASK creating the partial pressure gradients needed to move bloodOin 2 & CO2? = CO2 pulmonary moist capillary alveolar alveolar airmembrane This causes the CO2 to move out of the bloodstream and into the air of the alveoli. REQUIREMENTS FOR GAS EXCHANGE 5)circulatory systemis required to quickly and A ________________ deliver gases___________ to and from the effectively respiratory surface. QUICK How is the circulatory system aiding in TASK creating the partial pressure gradients needed to move bloodOin 2 & CO2? = O2 pulmonary moist capillary alveolar alveolar airmembrane The capillaries keep carrying O2 rich blood AWAY from the alveoli. This creates a higher pP of O2 in the air than in the blood. REQUIREMENTS FOR GAS EXCHANGE 5)circulatory systemis required to quickly and A ________________ deliver gases___________ to and from the effectively respiratory surface. QUICK How is the circulatory system aiding in TASK creating the partial pressure gradients needed to move bloodOin 2 & CO2? = O2 pulmonary moist capillary alveolar alveolar airmembrane This causes the O2 to move from the air of the alveoli into the bloodstream. Gas Exchange  Alveolar respiration- Determines amount of CO2 in the body  Increased CO2, primarily in body fluids as carbonic acid, causes pH to decrease below 7.4 (normal).  Decreased CO2 causes pH to increase above 7.4.  Kidneys excrete excess hydrogen ions, which keep serum bicarbonate levels near normal.  Lungs eliminate carbonic acid by blowing off more CO2; conserve CO2 by slowing respiratory volume and reabsorbing HCO3  In analysis of ABGs, the PaCO2 is the best determinate of alveolar ventilation. Gas Exchange  Perfusion- Blood supply to the Lungs. Lungs receive nutrients and oxygen. Two methods of perfusion are bronchial and pulmonary circulation.  Bronchial Circulation Bronchial arteries supply blood to trachea, bronchi, supporting tissues, nerves and outer layers of the pulmonary arteries and veins. Bronchial circulation is not involved with gas exchange. Gas Exchange  Pulmonary Circulation Transports venous blood from the right ventricle to the lungs Divides into the right and left branches to supply the right and left lungs. Blood circulates through the pulmonary capillary bed where diffusion of O2 and CO2 occurs. Blood then returns to left atrium through the pulmonary veins. Referred to as low-pressure system Decreased pulmonary artery pressure results in decreased perfusion to lungs. Gas Exchange  Ventilation/Perfusion Ratio (V/Q Ratio)- used to determine cardiopulmonary status.  Effectiveness of airflow with the alveoli (ventilation)  Adequacy of gas exchange within the pulmonary capillaries (perfusion) Low V/Q ratio: Shunts. This is seen with obstruction of the distal airways, such as pneumonia, atelectasis, tumor, or mucous plug. High V/Q ratio: Dead space. This is characteristic of a variety of disorders, including pulmonary emboli, pulmonary infarction, and cardiogenic shock. Silent Unit: Absence or limited ventilation and perfusion. This is seen with pneumothorax and severe acute respiratory distress syndrome. Objective 3 Figure 19-4 pg. 286 Respiration and Acid-Base Balance Oxygen Transport  Oxygen transport in the body occurs in two basic steps involving the reversible loading and unloading of hemoglobin with oxygen.  Hemoglobin is loaded with oxygen as it passes through the pulmonary capillaries and is then transported to the peripheral tissues where the oxygen is unloaded.  Greater portion combines with hemoglobin in RBCs; oxyhemoglobin  CO2 diffuses from the tissue cells to the blood  https://youtu.be/WXOBJEXxNEo Respiration and Acid-Base Balance  Imbalances- compensated in the following ways: Respiratory acidosis- kidneys retain more HCO3 to raise the pH. Emphysema, asthma, pneumonia Respiratory alkalosis- kidneys excrete more HCO3 to lower pH. Trauma, anxiety/hyperventilation Metabolic acidosis- lungs “blow off” CO2 to raise pH. Diarrhea, DKA, kidney disease, Kussmaul respirations Metabolic alkalosis- lungs retain CO2 to lower pH. Tachycardia, asymptomatic, tetany  https://youtu.be/Gx7-PHLzYaY  Respiration and Acid-Base Balance  Respiratory insufficiency develops if there is too much interference with ventilation, diffusion, or perfusion. Abnormalities can lead to: Hypoxia- decreased O in inspired 2 air – Chronic hypoxia will lead to clubbing of fingers Hypoxemia- decreased O in the 2 blood Hypercapnia- increased CO in the 2 blood Hypocapnia- decreased CO in the 2 blood Respiration and Acid-Base Balance  Primary factors  Airway resistance Airway resistance related to airway diameter, rate of air flow, and speed of gas flow Narrowed airway results from increased or thick mucous, bronchospasm, or edema. Will have wheezing due to narrowed airway diameter Asthma, chronic bronchitis, emphysema, tumor, foreign body  Lung compliance Decrease surfactant, fibrosis, edema, atelectasis Effects of Aging on Respiratory System Gerontologic Considerations  Cartilage in nasal septum increases in length and can harden; airflow changes increasing risk for OSA.  Alveoli walls become thinner and contain fewer capillaries; decreased gas exchange.  Increased presence of collagen in alveolar walls.  Lungs lose elasticity; diminished lung expansion and increased dead space.  Muscle tone, cough reflex, gag reflex, mucous and cilia decrease.  At risk for increased risk for respiratory disease. Respiratory System Data Collection Respiratory Assessment  History  General health Family hx of respiratory disease Frequency of respiratory illness, allergies Smoking hx current or past; single most important contributor to lung disease.  Respiratory treatments or medications, pulmonary tests, occupation, ACE inhibitors  Exercise tolerance, pain, and level of fatigue Respiratory System Data Collection Respiratory Assessment  Physical Examination  Skin color; LOC; mental status; respiratory rate, depth, effort, and rhythm; use of accessory muscles; and shape of the chest and symmetry of chest movements; finger clubbing Inspect nose for signs of injury, inflammation; tracheal symmetry  Dyspnea, pain on inspiration, increased or more frequent cough, increased sputum production or change in color/consistency of the mucus, wheezing, hemoptysis, atelectasis (decrease expandability of lungs) Respiratory System Data Collection Respiratory Assessment  Percussion; tactile or vocal fremitus: say “99”  Auscultation  Normal breath sounds Vesicular sounds: produced by air movement in bronchioles and alveoli. Heard over lung fields. Quiet and low pitched. Long inspiration, short expiration. Bronchial sounds: produced by air movement through the trachea. Heard over trachea. Loud with long expiration. Bronchovesicular sounds: heard between trachea and upper lungs. Pitch medium with equal inspiration and expiration. Respiratory System Data Collection Respiratory System Data Collection Breath Sounds  Adventitious breath sounds Crackles (formally called rales): resemble static or the sound made by rubbing hair strands together in one’s ear; may or may not clear with coughing. Course, high-pitched, non-continuous sound. May be an indication of inflammation or congestion. Wheezes: sibilant (hissing or whistling) or sonorous (full and deep); continuous musical sound heard during inspiration and expiration Sonorous wheezes (formerly called rhonchi): lower pitched and heard in trachea and bronchi Friction rubs: heard as crackling or grating sounds on inspiration or expiration. Do not change with coughing.  Pulse oximetry O2 content/saturation of hemoglobin Measures oxygen saturation (SpO2) of arterial blood Diagnostic Test for the Respiratory System Diagnostic Test  Arterial Blood Gases (ABGs) Determine blood’s pH; O2-carrying capacity; and levels of O2, CO2, and HCO3 Provides data on potential impairment in ventilation Obtained through an arterial puncture at the radial, brachial, or femoral artery. Frequently ordered when a patient is acutely ill or has a history of respiratory disorders. Diagnostic Test for the Respiratory System  Normal Values for arterial blood gases (ABGs) pH- hydrogen ion concentration, acidity, or alkalinity of the blood. Normal value 7.35-7.45 PaO2- partial pressure of oxygen in arterial blood. Normal value 80-100 mm Hg PaCO2- partial pressure of carbon dioxide in arterial blood. Normal value 35-45 mm Hg HCO3- bicarbonate ion concentration in the blood. Normal value 22-26 mEq/L SaO2%- arterial oxygen saturation or % of the O2 carrying capacity of the blood. Normal value >94%  Diagnostic Test for the Respiratory System  Pulmonary Function Studies Measures the functional ability of the lungs or how much air moves in and out of the lungs during inspiration & expiration Diagnose pulmonary conditions and to assess preop respiratory status. Obtained with a spirometer. Results vary according to age, sex, weight, and height. Best done sitting or standing. Should not be performed within 2 hours after a meal. Instruct patient to wear loose fitting clothing. Nose clip prevents air from escaping through the nose. Bronchodilators may be used after initial spirometry to measure improvement or response to medication. Diagnostic Tests for the Respiratory System  Sputum Studies Examined for pathogenic microorganisms and cancer cell. Culture and sensitivity test done to diagnose infection and prescribe antibiotics. Collect in sterile container early in morning or after aerosol treatment. Instruct to rinse mouth with tap water before specimen collection. Instruct to take several deeps breaths, cough forcefully, and expectorate into container; collect at least 1 to 3 mL Collect specimen before beginning antibiotic therapy. Diagnostic Tests for the Respiratory System  Imaging Studies Chest x-ray show size, shape, and position of lungs and other structures in thorax. Purpose is to screen for asymptomatic disease and diagnose tumors, foreign bodies, and other abnormal conditions. Fluoroscopy enables MD to view the thoracic cavity with all contents in motion to precisely diagnose location of tumor or lesion. CT scanning or MRI produce axial views of lungs to detect tumors and other lung disorders in early stages. Diagnostic Tests for the Respiratory System  Pulmonary Angiography Radioisotope study of lungs that assesses arterial circulation; detects PE Screen for allergies to iodine, shellfish or contrast dye. Inform patient they will experience warm, flushed feeling and may have urge to cough. After procedure inspect for swelling, discoloration, bleeding, or hematoma. Assess distal circulation and sensation. Report abnormal finding immediately. Bedrest for 2-6 hours following procedure. Diagnostic Tests for the Respiratory System  Lung Scan-several types may be done for diagnostic purposes.  V/Q scan Radioisotopes administered intravenously detect patterns of blood flow and radioisotopes administered via inhalation detect air movement and distribution in the lungs. Used to diagnose PE, lung cancer, COPD and pulmonary edema Assess for allergies to iodine, shellfish and contrast dye May require patient to change positions or hold breath for brief periods. Diagnostic Tests for the Respiratory System  Gallium Scan Determines if inflammation, abscesses, adhesions, or tumors are present in the lungs. Intravenous radioisotope; gallium injected then scans are taken at intervals up to 48 hours after gallium injection. Scans show gallium uptake by the lung tissues  PET scan Radioisotopes intravenously with advanced technology detects blood flow, functioning of organs, view metabolic changes in lung tissue. Evaluates malignancies. Diagnostic Tests for the Respiratory System  Bronchoscopy Used to diagnose, treat, or evaluate lung disease; obtain a biopsy of lesion or tumor; obtain a sputum specimen; perform aggressive pulmonary cleansing; or remove a foreign body. Allows direct visualization of the larynx, trachea, and bronchi. NPO 6 hours before bronchoscopy. After procedure assess for gag reflex and cough Suction equipment at bedside. Place in semi-Fowler’s position with head to one side. Objective 7 Diagnostic Tests for the Respiratory System  Laryngoscopy Laryngoscope provides direst visualization of larynx Diagnose lesions, evaluate laryngeal function, and determine inflammation. Can also treat/dilate laryngeal strictures and biopsy lesions.  Mediastinoscopy Visualization of mediastinum after incision above sternum and insertion of mediastinoscope. Can visualize lymph nodes and obtain biopsy if needed. Diagnostic Tests for the Respiratory System  Thoracoscopy Examination of pleural cavity. Endoscope inserted through incision in intercostal space to visualize specific area. Aspiration of fluid, biopsies, evaluate pleural effusion and pleural diseases. Stage tumors Chest tube may be inserted following procedure. Diagnostic Tests of the Respiratory System  Thoracentesis Aspiration of air of fluid from pleural space by inserting a needle into the chest wall. Bloody fluid suggest trauma, purulent fluid is infection, serous fluid associated with cancer, inflammatory conditions, or heart failure. Therapeutic thoracentesis, 1-2 L fluid may be removed. Medication may be instilled directly into pleural space to treat infection. Done at bedside with local anesthetic. Sitting up or side-lying on unaffected side. Objective 7 Diagnostic Test of the Respiratory System  Objective Data Collection for the Respiratory System (Table 29.3 pg. 496) Respiratory Integumentary Neurologic Gastrointestinal Other Considerations  Breathing Exercises Diaphragmatic Breathing Pursed-Lip Breathing  Oxygen Therapy Low-Flow Devices Masks High-Flow Devices Risks of Oxygen Therapy Other Considerations  Chest Drainage  Tracheostomy  Intubation  Mechanical Ventilation  Noninvasive Positive-Pressure Ventilation BiPap CPAP Nursing Care Plan Nursing Care Plan-Bronchoscopy  Nursing Diagnosis Fear, Risk for Aspiration  Interventions Acknowledge fear, simple explanations; inform that client will receive medications for anxiety Assess cough/gag reflex Available suction; semi-Fowler’s position Report complications of pneumothorax, dysrhythmia, or bronchospasm  Outcomes Client tolerates procedure without negative effects and maintains patent airway and minimal potential complications. Question #1 Movement of air into and out of the lungs sufficient to maintain normal arterial oxygen and carbon dioxide tensions is termed: A) Perfusion B) Ventilation C) Diffusion D) Inspiration Answer to Question #1 B) Ventilation Rationale: Ventilation is the actual movement of air in and out of the respiratory tract. This process requires a patent airway and intact and functioning respiratory muscles. Question #2 While conducting the physical examination during assessment of the respiratory system, which of the following would describe lung sounds produced by air movement through the trachea and are loud with long expiration? A) Bronchovesicular sounds B) Bronchial sounds C) Sonorous wheezes D) Vesicular sounds Answer to Question #2 B) Bronchial sounds Rationale: Normal bronchial lung sounds are auscultated over the trachea and are loud with long expiration. Question #3 The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation on a patient who presents in respiratory distress. What site can ABGs be obtained from? A) A puncture in the radial artery B) The trachea and bronchi C) A swab from the nasopharynx D) An intravenous catheter in the arm vein Answer to Question #3 A) A puncture in the radial artery Rationale: ABGs determine the blood’s pH; oxygen- carrying capacity; and levels of oxygen, CO2, and bicarbonate ion. Blood gas samples are obtained through an arterial puncture at the radial, brachial, or femoral artery.